Code Blue: Defibrillation
You’re getting on with your duty as usual. Everything just started out right, conscious patient, not-so busy work environment. This ought to be a stress-free duty. You’re just beginning to prepare your due medications when everything turned upside down.
“Mrs. Santos? Mrs. Santos?” You check for the pulse and breathing.
“She’s not breathing. Call the code!”
The rescue/code team has arrived as you perform continuous CPR. Ventilation and emergency medications have been given, O2 saturation and ECG tracings have been checked. The doctor orders defibrillation.
This is often the scenario we observe in movies and television shows. A busy clinical setting where doctors and nurses try to move as quickly and at the same time as accurately as possible. It’s as if everything’s a blur. The defibrillation scenario is a common act we play in demonstrations of happenings in the clinical area. We portray it so much that sometimes we think we already know and master what we are doing, but what we are yet to discover is that working in the hospital, dealing everyday with people’s lives is not always that conventional and that our job being nurses isn’t always as easy as it seems.
Defibrillation is defined as the process wherein an electric shock is sent to the heart to stop an arrhythmia with the use of an electrical device called a defibrillator, resulting in the return of a productive heart rhythm.
Defibrillation is often used in emergency cases for the purpose of correcting life-threatening arrhythmias such as countering the onset of ventricular fibrillation or pulseless ventricular tachycardia, which is a common cause of/ and cardiac arrest.
When it comes to cardiac emergencies, the procedure must be performed immediately after identifying that the patient is experiencing an arrhythmia. You may identify this through signs like lack of pulse and unresponsiveness, you may also confirm the arrhythmia in ECG tracings. You may note randomly occurring chaotic electrical activity without discernable depolarization or repolarization waveforms for V-fib. V-tach on the other hand appears as wide complex tachycardia on the tracings.
In non-life threatening situations, atrial defibrillation may be ordered to treat atrial fibrillation or flutter.
However, this procedure is not indicated for pulseless electrical activity and asystole or flatline wherein there is complete cessation of cardiac activity since they are not responsive to defibrillation.
Also, defibrillation in the clinical setting must only be done by professionals (doctors, nurses and health professionals) who are trained in Advanced Cardiac Life Support, though outside of the hospital, AEDs or automated external defibrillators are also available in schools and other establishments. These AEDs are very user friendly, providing step by step instructions that allow bystanders to defibrillate in an emergency until trained medical personnel arrive.
How it works
Cardiac arrhythmias like ventricular tachycardia, fibrillation, and cardiac arrest prevent the heart from pumping blood to the body and can possibly cause irreversible damage to the major organs such as the brain and heart. With every minute that the heart fibrillates, about 10% of the ability to restart the heart is and death can occur within minutes if left untreated.
In ventricular arrhythmias, defibrillation works by applying a controlled electrical shock to the heart causing depolarization of the entire electrical conduction system of the heart. Then, when the heart undergoes repolarization, the normal electrical conduction may occur and the myocardium ideally returns to a normal rhythm.
However, there must be enough used energy for defibrillation, if not then the heart may not be completely depolarized which may result to non-termination of ventricular tachycardia or fibrillation. In other cases, ventricular arrhythmia may recur, such as if the heart does not get enough oxygen or if there exists the instability of the electrolytes in the cardiac cells.
In the clinical setting, nothing is predictable. Anything could happen in just a blink of an eye that is why we nurses must always be ready at all times. However, amidst all these emergencies, it is important that we still stay as calm and composed as possible. Maintain a clear head. Don’t panic. In times like these, quick actions are not the only ones needed, but also a stable mind can come in very handy.